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← Return to Gleason 6 (3+3) treatments
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Just curious. You said you had a "single biopsy" of your prostate. That is odd. As an Interventional Radiologist, we were doing US guided biopsies in the 1990s before the Urologists started doing them and eventually took over that procedure. Even back in the 1990s we were doing 8-12 biopsies throughout the gland. Of course, no biopsy of any organ can exclude cancer. You are taking a very small sample relative to the entire size of the gland and can miss tumor on the biopsies. As you allude to, using fusion guided techniques to guide the biopsy to any suspicious areas is very helpful. If the biopsy is negative for cancer or yields a G6, there should be short term follow up PSA. A 20% or more rise in the PSA over one year is concerning and usually warrants further investigation.
Replies to "Just curious. You said you had a "single biopsy" of your prostate. That is odd. As..."
My apologies for the mis-statement. I should have said I had a single biopsy procedure performed. The biopsy consisted of 12 needles/cores. Only 1 of the 12 cores had cancer in it, but it was US guided, so I think it was just a blind grid pattern.
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Thanks for your comment and question. I’ve see some of your other comments and they’ve always been intelligent and considerate. Kudos!
My apologies for not being clear regarding my comment. I only had a single biopsy experience January 2020. It was a US guided transperineal stereotactic mapping biopsy and they took 25 cores. My insurance (Aetna) would not authorize payment for anything more than a random TRUS biopsy so I paid the difference. MRI of December 2019 previously showed a 1.4 cm x 0.9 cm Pi-rads 4 lesion in the right anterior peripheral zone at the apex of the prostate. The biopsy revealed Gleason 6 (3 +3] (Grade Group 1] tumor in one of 4 cores 5mm discontinuously involving 25% of submitted tissue from the right anterior apex.
My November 2019 PSA (prior to the MRI and the biopsy) was 4.75. My next PSA reading was May 2020 (6 mos later) when the PSA jumped to 6.51. No further PSA tests, biopsies, or MRI’s were taken before I underwent focal brachytherapy in June 2020. I distinctly remember calling the RO and asking if we needed to repeat the MRI or biopsy with the precipitous rise in PSA in mind and I asked to have a decipher test run on PCa positive sample. I was told that none of that was necessary. All this was in the middle of the pandemic and I was assured that no further investigation was needed. That turned out to be incorrect.
MRI and a PET-PSMA scan in December 2023 showed two PI-RADS 5 lesions and involvement of two local lymph nodes. Two different medical teams from different center of excellence hospital systems weighed in with their belief that the 2020 biopsy missed significant cancer. I had salvage RP Jan 2024. The pathology showed Gleason grade 9 in one lesion and grade 8 in another EPE and a positive margin. The prostate bed was clear. I lymph node tested positive for PCa and a second suspicious lymph node could not be safely removed and will be treated with salvage RT. My post RP nadir was 0.40. I started Orgovyx and Zytiga in May 2024. My PSA is now undetectable. I start RT on the lymph node basin the first week in June. My outlook is hopeful.
I thought I was well educated in 2020 but I now realize that it would have been smarter to “pump the brakes” and seek a second opinion rather than rush into an experimental procedure that failed.